Project Summary. Chagas' disease (Trypanosoma cruzi infection) transmission occurs between a triatomine insect vector and humans, although other less common transmission routes exist. Acute disease in humans is normally nonspecific and mild; however, approximately 20-30% of those infected with the parasite will go on to develop cardiomyopathy, characterized by conduction system abnormalities, progressive dilated cardiomyopathy, and ultimately death. Early diagnosis is critical for initiating treatment to prevent irreversible fibrosis and improve health outcomes. Latin American immigrants to the United States are at risk for having undiagnosed disease due to the lack of knowledge among clinical providers. Additionally, in the southern United States, we are finding mounting evidence of autochthonous disease transmission between infected vectors and humans. Texas has the highest number of locally acquired human cases. In fact, the first historical case and the first geographic clustering of locally acquired human cases in the United States were identified in southeastern Texas. This state also has a substantial veterinary disease burden, particularly among shelter dogs and outdoor-caged primates. Historical studies dating back to 1935 support a continuous landscape of disease transmission to humans and other mammalian reservoirs in this potentially endemic area. Unfortunately, epidemiologic studies of infection among residents are severely lacking, and the true burden of disease has not been fully elucidated in this area. This current proposal aims to screen Texas residents attending a well-established annual community health fair for prevalence of Trypanosoma cruzi infection, identify risk factors for infection, and assess transmission sources for infection. Identification of Trypanosoma cruzi infected populations is essential to (1) better understand the epidemiology of Chagas disease in southern Texas, and (2) identify high risk populations to target for screening and intervention. This innovative pilot project will be the first to assess Trypanosoma cruzi infection prevalence among Texas residents to better ascertain disease burden and transmission sources. The overall goal of this study is to determine prevalence of Trypanosoma cruzi infection among residents and evaluate where their infection was acquired for future interventions. We hypothesize that roughly 1-5% of those tested will be positive on multiple diagnostic assays confirming infection. This project will foster new collaborations between resident epidemiologists with expertise on human Chagas disease, the Texas State Guard, and the Department of State Health Services. The long-term goals of this exploratory pilot study are to use the data derived from screening to identify high risk populations to target for prevention/intervention and establish a clinical cohort for a longitudinal study to establish prognostic biomarkers and assess clinical manifestations. This high impact study will critically impact the understanding of Chagas disease burden of Texas residents, with an opportunity to identify high-risk populations to target for prevention and intervention efforts.